The Legal Basis and
Structure of Public Health in
New York State
Structure of Public Health
in New York State
• State
• Oversees and coordinates public health
statewide
• Local
• Authority within geographical jurisdiction
• City/town/village
• County/Part-county
• Consolidated
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NYS Department of Health
Powers and Duties (PHL § 201)
• Supervise local health departments
• Supervise reporting and control of disease
• Supervise vital records (deaths, births and
marriages)
• Promote education in the prevention and
control of disease
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NYS Department of Health
Powers and duties (cont’d)
• Water supply
• Sewage disposal
• Swimming pools
• Ionizing radiation
• Bathing establishments (pools/beaches)
• Public Health Nuisances
• Public eating and drinking establishments
• Hotels
• Camps
• Embalming and the practice of funeral directing
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NYS Department of Health
The Commissioner shall
“…take cognizance of the interests of health
and life of the people of the State, and of all
matters pertaining thereto and exercise the
functions, powers and duties of the
department prescribed by law” — PHL § 206(1)(a)
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NYS Department of Health
NYSDOH Commissioner has broad authority
to:
• Supervise all local boards of health and health
officers
• Investigate epidemics, cause of disease
• Enforce the PHL and State Sanitary Code
• Inspect State Institutions
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Public Health Council
(PHL §220 – §229)
• Commissioner of Health, and
• 14 members, appointed to 6-year terms by the Governor
with the advice and consent of the Senate
“The public health council shall have power by the
affirmative vote of a majority of its members to establish,
and from time to time, amend and repeal sanitary
regulations, to be known as the sanitary code of the state of
New York, subject to approval by the commissioner. “
— Public Health Law §225(4)
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Local Boards of Health
PHL Article 3, Title 1 (§§ 300–312)
“There shall continue to be local boards and
departments of health and health officers in the
several counties, cities, villages and towns of the
state except as otherwise provided by law.”
— Public Health Law §300
• New York City given special status (PHL §312)
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Local Boards of Health
Powers (PHL § 309)
• Issue civil subpoenas
• Compel the attendance of witnesses
• Administer oaths and compel testimony
• Issue warrants
• Prescribe and impose penalties for the violation of,
or failure to comply with, any of its orders or
regulations, or any of the regulations of the State
Sanitary Code
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Local Public Health Officers
(Select) Powers and Duties (PHL § 324)
• Enforce the Sanitary Code
• Report communicable disease and births and
deaths
• Promote the prevention of “prevalent” diseases
and preservation and improvement of health
• Sanitary survey and supervision within
geographical territory
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County or Part-County
Health Districts
• Created by county board of
supervisors
• With NYSDOH approval
• Includes consenting cities in
county
• Where not all consent, part-county
districts result
Article 3
Title 3
§§ 340–357
• Local health districts continue to
exist unless abolished
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County/Part-County
Boards of Health
Powers and Duties (PHL §§ 347–348)
• All powers and duties of local boards of health,
PLUS
• Limited contracting authority
• Limited enforcement of PHL provisions related to
tobacco and smoking
• Adopt local rules, regulations, etc. for protection of
public health in district—including a local Sanitary Code,
provided it is not inconsistent with the State Sanitary
Code or PHL
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County Health
Commissioner
• Must be NYS-licensed physician
• Powers and Duties
• Full-time position with limited authority for other duties
• Supervision and control of patient treatment in facilities
operate by districts
• Limited contracting authority
• Collection of current and overdue fees for patient
treatment
• Duties of local health officer
10 NYCRR §§ 11.10–11.11
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Public Health Director
• Same powers as County Health
Commissioner EXCEPT
• Must work in concert with a medical consultant
(who must be a NYS-licensed physician)
10 NYCRR §§ 11.180–11.182
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Laws Enforced by Local
Health Department/District
• Public Health Law (aspects)
• State Sanitary Code
• Or approved local sanitary code
• Local regulations/ordinances
• Any number of health-related topics, such as
body-piercing parlors, local septic system
inspections, etc.
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Public Health Law (Generally)
• 50 Articles, including:
• Article 2
NYSDOH
• Article 3
Local Health Organization
• Article 13-e Tobacco Control
• Article 14
Regulation of Children’s Camps
• Article 21
Communicable Disease
• Article 30
Emergency Medical Services
• Article 41
Vital Statistics
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NY Codes,
Rules and
Regulations
(NYCRR)
• Title 10 – Health
• 7 volumes
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State Sanitary Code
(10 NYCRR Parts 1-24)
§ 225(5) The sanitary code may:
(a) deal with any matters affecting the
security of life or health or the preservation
and improvement of public health in the
state of New York, and with any matters as
to which the jurisdiction is conferred upon
the public health council.
— Public Health Law §225(5)
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Sanitary Code
• Statutory authority is Public Health Law § 225(5) (Selected)
• Prescribe the qualifications of public health personnel
• Regulate and promote health in Indian reservations
• Designate communicable diseases
• Regulate certain labor camps, temporary residences, and
mass gatherings
• Regulate ionizing radiation and nonionizing
electromagnetic radiation installations
• Facilitate epidemiological research into the prevention of
environmental diseases
• Regulate bottled water
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Sanitary Code
Application
• Statewide
• Supersedes inconsistent or less stringent local
ordinances
• Note: Any local sanitary code provisions must be filed
with NYSDOH
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Sanitary Code
Structure
• Part 5 — Public Water Systems
• Part 6 — Swimming Pools and Bathing Beaches
• Part 7 — Temporary Residences, Mass Gatherings,
Children’s Camps
• Part 8 — Public Health Nuisances
• Part 11 — Qualifications of Public Health Personnel
• Part 14 — Food Service Establishments
• Part 15 — Migrant Farmworker Housing
and…
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Sanitary Code
Structure
• Part 16 — Ionizing Radiation
• Part 17 — Mobile Home Parks
• Part 40 — State Aid for Public Health Services
• Part 67 — Lead Poisoning Prevention and Control
• Part 74 — Approval of Realty Subdivisions
• Part 75 — Standards for Individual Water Supply and
Individual Sewage Treatment Systems
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Disease Reporting
Required by Statute
• PHL Art. 21
Communicable diseases
• PHL Art. 22
Tuberculosis
• PHL Art. 23
STDs
• PHL Art. 21, Title III
HIV
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Disease Reporting
Required by Regulation (10 NYCRR)
• Part 2
Communicable disease list
• Part 2.16
Outbreak reporting
• Part 23
STD control
• Part 63
HIV reporting, testing, and
confidentiality
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Basic Reporting Authority
• Physicians must report diseases listed in Part 2
of the Sanitary Code to local health officers.
(PHL § 2101)
• Where no physician is in attendance, as a general
matter the person responsible for the place the
disease occurs must report
• NYS licensed labs must report test results and
other required information (provider name, etc.)
and retain records (PHL § 2102)
• Counties must report to State (PHL §§ 2103,
2104)
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County Communicable
Disease Control
• PHL Articles 21 and 22
• Local Board of Health
• Shall guard against introduction of communicable
disease through medical inspection, investigation,
and control of all exposed persons and things
• May provide for care when necessary for protection
of public health (consult local public health service
plans)
• May quarantine
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Communicable Disease
• Health officer liability for errors in judgment in
ordering quarantine is limited, unless it is
unreasonable, arbitrary, malicious, or injurious due
to excess of authority
• See, e.g., Crayton v.Larabee, 220 NYC 493 (1917)
• Communicable disease records are not privileged
and are available to court
• EXCEPT where information is made privileged as to
specific diseases, such as HIV/AIDS and STDs
• See, e.g., Thomas v. Morris, 286 NY 266 (1941)
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STD Control
PHL § 2300–2306
• A health officer can require a suspected
STD carrier to undergo an exam and lab
testing
• If such person refuses, a court order may be
obtained
• Minors may be treated on their own consent
• All reports are confidential, except limited
disclosure in criminal cases and family court if
patient consents
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Other Disease
Reporting Mandates
• Cancer
• Provider must report to
health officer where
patient resides (PHL §
2401)
• Reports are confidential
• Disclosure for approved
research permitted (10
NYCRR Part 1.31)
• Tuberculosis
• Provider must report to
health officer (PHL §§
2210, 2225)
• Reports are confidential
• Health officer has a duty
to control a nuisance
(PHL § 2223)
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Military Induction Centers
• Disclosure of cancer,
tuberculosis, and venereal
disease information is permitted
to medical examiners at
induction centers (10 NYCRR
Part 1.30)
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Disease Reporting and
Control
Summary of Legal Basis
• Statute—PHL Articles 21, 23, 27
• Implemented in regulations
• May involve judicial process
• For example, orders for medical examination,
quarantine, and disclosure of information
• State is available to assist via program and legal
consultation, as needed
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